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  • paul_evans_90314

    Love this message from you...VERY on point.

    Type 1: Spontaneous myocardial infarction

    To diagnose type 1 MI, a blood sample must detect a rise or fall (or both) of cardiac biomarker values (preferably cardiac troponin), with at least one value above the 99th percentile. However, an elevated troponin level is not sufficient. At least one of the following criteria must also be met:
    Symptoms of ischemia
    New ST-T change or LBBB
    New pathologic Q wave on ECG
    Imaging evidence of new loss of viable myocardium or wall motion
    Identification of an intracoronary thrombus by angiography or autopsy

    Type 2 myocardial infarction:Due to ischemic imbalance

    Type 2 MI is caused by a supply-demand imbalance in myocardial perfusion, resulting in ischemic damage.
    This specifically excludes acute coronary thrombosis.
    It can result from marked changes in demand or supply (eg, sepsis) or from a combination of acute changes and chronic conditions (eg, tachycardia with baseline coronary artery disease).
    Baseline stable coronary artery disease, left ventricular hypertrophy, endothelial dysfunction, coronary artery spasm, coronary embolism, arrhythmias, anemia, respiratory failure, hypotension, and hypertension can all contribute to a supply-demand mismatch sufficient to cause permanent myocardial
    damage.
    The criteria for diagnosing type 2 MI are the same as for type 1
    Therapy should instead be directed
    at the underlying supply-demand imbalance
    and may include volume resuscitation, blood
    pressure support or control, or control of
    tachyarrhythmias.
    In the long term, treatment to resolve or prevent supply-demand imbalances may also include revascularization or antithrombotic
    drugs, but these may be contraindicated in the acute setting.


    I have used this query when I see a rise and fall of troponins and vague reference to it:

    Please document as a final diagnosis the most appropriate clinical finding supported by your diagnostic efforts.

    __ Demand ischemia without Myocardial Infarction
    __ Non ST elevation MI (NSTEMI) secondary to known CAD
    __ Unstable Angina
    __ NSTEMI 2/2 supply demand mismatch also known as Type 2 MI __ Other (please specify) __ Unable to determine

    September 10
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  • tracyaboldt@gmail.com
    Hi Paul, 

    I hope all is well as you head into a long weekend. Would you mind if I put you in touch with my CDI educator?  She has a few PCS questions I think you may be able to help her with?  
    August 31
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  • tenglish1

    I was wondering if you could help me with this scenario? If a patient had a open colectomy with Ileostomy late June 2018 and returned in late August 2018 for closure of loop ileostomy with resection of stoma and Nutrition has documented that the patient's current weight represents a loss of 17-21% body weight in 2 months and now has a BMI (18.84) . In June the BMI was ( 22.86). The surgeon is documenting " Frail Appearing" patient is presently NPO and on IVF's awaiting Bowel function. Would you be thinking some form of malnutrition ? although the surgeon is not treating the patient for the Malnutrition. Nutrition continues to follow the case.

    I was thinking it appears the patient may have some malnutrition and at present not sure how long the patient would remain NPO? Since we do so many cases I would like to make the Surgeon aware of this finding but I feel there is no  treatment other than Nutrition following the case. Would like to hear your opinion and what you would do? I wish this was a surgeon I could verbally speak with to explain but this surgeon is unapproachable and confrontational at all times. Administration is pushing us to Identify Malnutrition cases, I feel my hands are really tied here. This case has the potential to be advanced to a cc. Appreciate any response to guide me better. Thank you for reading my question. Hope to hear from you soon.  Have a great day!

    August 27
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